Lifeline Representative Application

RELIABLE MARKETING GROUP CORP

"Empowering Economic growth through job creation"
Lifeline Representative Application

Welcome! Please fill out the application below to the best of your ability. If you have any questions please contact the person who referred you to this position.
Referral Name*
Please! Select the manager or company that you were in contact with prior to filling out this application.
Select the ETC your interested in!*

Stand Up (50 States)EXCESS (50 States)ACCESSPROSPER
Full Name (Exactly as shown on drivers License or ID card)*

PrefixFirst NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Must match DL/ID.
Social Security*
SS#
Phone Number*

Area CodePhone Number
Email*
example@example.com
Shirt Size*
Please choose your shirt size.
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current address move in date?

MonthDayYear
Date
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous address move in date?

MonthDayYear
Date
RAD ID (If not registered please contact your Manager to register)*
Photo of unexpired DL/ID.*

Cancelof
Headshot Photo (no selfie filters)*

Browse Files
Upload a front facing photo of self ! Cancelof
EXAMPLE OF HEADSHOT BELOW!!
Please be on the look out for an email from SIGN NOW that will contain a W9 form which you need to fill out, sign and submit as soon as you receive it!

Yes! I understandNo! I don’t want to work!
Do you have Lifeline experience? (Not Required)*

YesNo
If yes, which companies have you worked for?
Can you pass a background check?(Selecting yes would be considered your electronic signature for background submission by R.M Corp)*

YesMaybeNo
If "yes", please leave blank. If answered "no", or "maybe" , please explain below.
Do you have Reliable transportation?*

YesNo
Do you have Android tablet with at least 5.0 mp camera and data connection?*

YesNo
Do you understand and accept that this position is a 1099/CONTRACTOR with commission based compensation and not hourly pay.*

Yes! We make more that way!No! your application will be discarded.
Tell us about yourself!
By submitting this application you agree to provide your information for a potential 1099 contract with lifeline free Cell Phone Government program. You understand that if you agree to a contract you will be paid weekly, according to our formula, and through a pay card or direct deposit of our choosing. Remember to work hard be great, consistent and "Reliable". “We are Reliable Marketing"*

I Agree! I want a job.No! I don't want a job.
Should be Empty:

RELIABLE MARKETING GROUP CORP

Lifeline Representative Application